U VISA INTERVIEW GUIDE

INTERVIEWER:

__________
Date: _____/_____/_____

BACKGROUNDINFORMATION

1. Name___________________________Aliases________________________________
2. Dateofbirth________________________PlaceofBirth___________________________
3. Address:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
4. SecondAddress:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
5. TelNos.:
Home_______________________
Work_______________________
Message_____________________
6. Areyoumarried?YesNo
Ifyes,whatisyourspousesstatus?
U.S.citizenLPROther_______________
*Note- This Interview Guide is a modified version of a guide
preparedbytheLegalAidFoundationofLosAngeles

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7. Doyouhavechildren?Yes No
Ifyes,listALLchildren:
Name

Birthdate

Birthplace

Age

Ischildwithyou?
Ifno,whereis
s/he?

8. Doyouhaveunmarriedsiblingsunder18?Yes

No

ImmigrationStatus

Ifyes,listALLunmarriedunderagesiblings:
Name

Birthdate

Birthplace

Age

VICTIMOFCRIMINALACTIVITY
9.

Whatcriminalactivitywereyouavictimof?

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Issiblingwithyou?
Ifno,whereis
s/he?

ImmigrationStatus

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
10. Nameofthepersonwhoengagedinthecriminalactivity,andhis/herdateofbirth(if
known):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
11. Whatisyourrelationshiptothepersonwhoengagedinthecriminalactivity?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
12. Whendidthecriminalactivityoccur?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Wheredidthecriminalactivityoccur?

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___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
13. Didyoureportthecriminalactivity?YesNo
Ifyes,pleaseanswerthefollowingquestions:
a)Whichpolicestationdidyoureportto?
___________________________________________________________________________
___________________________________________________________________________
b)Nameofthedetective/officer
___________________________________________________________________________
c)TelephoneNumberforthedetective/officer______________________________________
d)PoliceReportNo.__________________
14. Wastheperpetratorarrested?YesNoDontknow
Ifso,forwhatcriminalactivitywastheperpetratorarrested?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Ifno,whynot?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
15. Werechargesfiledincourt?YesNoDontknow
Ifchargeswerefiled,nameofthecourt
___________________________________________________________________________
CaseNumber_______________________________________________________________

Whatchargeswerebrought?

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___________________________________________________________________________
___________________________________________________________________________
Ifnochargeswerefiled,whynot?
___________________________________________________________________________
___________________________________________________________________________
16. Wastheperpetratorconvicted?YesNo
Ifyes,whatwasthesentence?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
17. NameoftheDAorCityAttorneywhoprosecutedthecase
___________________________________________________________________________
___________________________________________________________________________
TelephoneNumber___________________________
18. Haveyoucooperatedwithlawenforcementintheinvestigationorprosecutionofthecrime?
YesNo
Ifyes,describehowyoucooperatedandwhodidyoucooperatewith?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Ifno,whynot
___________________________________________________________________________

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___________________________________________________________________________
___________________________________________________________________________
Ifpossible,wouldyoubewillingtocooperate?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Isthereapotentiallawenforcementofficial,orjudgethatmaybewillingtoprovidea
certification?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
NOTESoncriminalactivity/victim:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

SUBSTANTIALHARMSUFFEREDBYCLIENT
19. Haveyousufferedphysicalinjuriesasaresultofthiscrime?Ifyes,pleasedescribeyour
injuries_____________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
20. Howwereyouharmedemotionallyasaresultofthiscrime?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Checklist of types of harm suffered:
** Advocates read off checklist and circle those that apply in parenthesis

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social isolation (victim can't: use phone, talk to family, no friends

allowed)
obsessiveness and possessiveness (jealousy, accusations of infidelity)
threatens to kill or harm (victim/property/children/animals)
economic abuse (controls all money, prevents her from getting a job, takes her money)
verbal abuse (name-calling, humiliates, constant criticism of herself/family)
threatens to deport (client, children, family)
threatens to take children away
____kicked out of house or threatens to do so
husband/abuser's family ever harmed or threatened to harm you? Describe:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
____other (please describe):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
21. Wereyourchildrenharmedasaresultofthiscrime?YesNo
Ifyes,pleasedescribehowtheywereharmed
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
22. Iftheapplicantisunder21,washis/herunmarriedsiblingunder18harmedasaresultofthis
crime?NotapplicableYesNo
Ifyes,pleasedescribehowhe/shewasharmed
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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23. Werethereotherwitnessesorvictims?YesNo
Ifyes,whoarethey?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Areyouincontactwiththem?YesNo
Ifyes,wherearethey?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Ifno,canyoufindthem?YesNo
NOTESonsubstantialharmsuffered:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

INADMISSIBILITYISSUES
UnlawfulPresence
24. WhendidyoufirstentertheU.S?________________Placeofentry___________________
25. HowdidyouentertheU.S?____________________________________________________
26. HaveyoulefttheU.S.sinceyourfirstentry?YesNo
Ifyes,givedetailsofeachentryandexit:

Departure Date

Arrival Date

Manner of entry

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Place of entry

Criminal History
27. Haveyoueverbeenarrested?YesNo
Ifyes,completethefollowing:
Date

Charge

Convicted Y/N?

Sentence or Outcome

PriorRemovals
28. HaveyoueverbeenbeforeanImmigrationJudge?YesNo
Ifyes,describewhyyouwereputindeportationproceedings
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Whatreliefdidyouapplyfor?
___________________________________________________________________________
___________________________________________________________________________
Whatwastheoutcome?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
29. HaveyoueverbeenstoppedordetainedbyINS,CIS,ICEorCBP?
______________________________________________________________________________
______________________________________
When?_____________________________________________________

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Outcome?__________________________________________________
30. HaveyoueverbeenordereddeportedorremovedfromtheU.S?
YesNo
Ifyes,wereyou(checkone):
__deported/removedbytheUSCIS
__Voluntarilydeparted
__Neverleft
Ifyes,when?________________________________________________
MiscellaneousInadmissibilityIssues
31. Doyousufferfromanyseriousmedicalconditionorcontagiousdisease?YesNo
Ifyes,pleasegivedetailsaboutyourillnessandtreatment
___________________________________________________________________________
___________________________________________________________________________
______________________________________________________________________
32. HaveyouengagedinprostitutionintheU.S.oranywhereintheworld??YesNo
Ifyes,pleasegivemoreinformation
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
33. Haveyoureceivedpublicbenefits?YesNo
34. Werethebenefitsprovidedfor:applicantapplicantschildren
Pleaseexplain:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
NOTESoninadmissibilityissues:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

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Miscellaneous
35. DoyouhaveanyotherfamilyintheU.S.?YesNo
Ifyes,who?_______________________________________________________
Whatistheirstatus?
a. U.S.citizenLPROther_________________________
b. U.S.citizenLPROther_________________________
36. Doyouwanttoapplyforvisasforyourfamily?YesNo
Ifyes,circleallthatapply:
Mother

Father
Spouse
Children
Sibling(s)(Onlyiftheapplicantisunder21andthesiblingisbothunmarriedandunder18.)
37. Whatisyourcurrentimmigrationstatus?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
38. HaveyoufiledanyapplicationswithUSCIS?YesNo
Ifyes,describewhatyouappliedfor,whenandtheoutcome
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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SupportingDocuments
Doyouhaveanyofthefollowingorcanyouobtainthesedocuments?

PoliceReport(s):
Date:

Agency:

Conviction Documents/ Case Disposition:

Date Convicted:

Court Name:

RestrainingOrder:DateObtained______________________

Certification from law enforcement:

Date

Photographs of Injuries

Medical Report:
Date:

Name of agency
and official:

Hospital:

DV Counseling Letter:
Date:

Agency Name or
Name of Counselor:

Letter from Battered Womens Shelter:

Date:

Name of Shelter:

Declaration of Witness:
Name:

Relationship:

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ClientDeclaration

Other Documents:
________________________________________________________________________
________________________________________________________________________

FORADVOCATE:IfclienthasapotentialUVisacase,evaluateiftheyshouldapplyfor
interimrelief:
IstheclientadirectvictimofacriminalactivitydescribedinINA101(15)(U)?
Isthecrimelistedinthestatute?
WasthecrimecommittedintheU.Sfairlyrecently
OR
Istheinvestigation/prosecutionofthecrimeongoing?
Hasclientcooperatedwithlawenforcement?
WilllawenforcementsigntheCertification?
Canclientshowsubstantialphysical/mentalharm?
Istherestrongcorroborativeevidenceofharm?
Doesclienthaveotheravenuesofimmigrationrelief?
OR
Doesclienthaveexistingimmigrationstatus?
Noinadmissibilityissuesarepresent
Clienthasbeenadvisedofthedangersinapplyingforinterim
reliefandhasconsented

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